Risk Factors for Recurrence in Stage III Colon Cancer after Curative Resection and 12 Cycles of Adjuvant mFOLFOX6

第三期大腸癌經腫瘤切除及輔助性化學治療後復發的危險因子

林育如(Yu-Zu Lin) ； 鄭厚軒(Hou-Hsuan Cheng) ； 黃聖捷(Sheng-Chieh Huang) ； 林宏鑫(Hung-Hsin Lin) ； 林春吉(Chun-Chi Lin) ； 藍苑慈(Yuan-Tzu Lan) ； 張世慶(Shih-Ching Chang) ； 王煥昇(Huann-Sheng Wang) ； 楊純豪(Shung-Haur Yang) ； 陳維熊(Wei-Shone Chen) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin) ； 姜正愷(Jeng-Kai Jiang)

《中華民國大腸直腸外科醫學會雜誌》 32卷3期 (2021/09) Pp. 139-149

https://doi.org/10.6312/SCRSTW.202109_32(3).11011

摘要

Purpose. After curative resection followed by adjuvant chemotherapy, patients with stage III colon cancer presented with a spectrum of risk for recurrence. We believe that identifying these risk factors will help to stratify the patients for optimal treatment. Methods. Patients with stage III colorectal cancer who underwent curative resection and adjuvant chemotherapy were identified from a prospectively constructed database at Taipei Veterans General Hospital between January 2006 and March 2015. Disease-free survival (DFS) was determined from the date of surgery to the date of recurrence. Covariates that were potentially related to five-year DFS were identified and analyzed using the Cox proportional hazard model. Results. A total of 197 patients were included in the study. The median follow-up time of the study was 6.1 years (range, 0.6-13). A total of 56 (28.4%) and 17 (8.6%) patients experienced recurrence and death, respectively. Recurrence and death were observed in 53 (26.9%) and 11 (5.6%) patients within 5 years of surgery, five-year DFS and overall survival (OS) were 73.1% and 94.4%. In the multivariable Cox regression model, the number of metastatic lymph nodes equal to or more than 15 (p = 0.02), obstruction at initial presentation (p = 0.03), and duration of mFOLFOX6 greater than 38 weeks (p ＜ 0.01) were significantly associated with recurrence within five years following surgery. Conclusions. For patients with stage III colon cancer receiving curative resection, the number of metastatic lymph nodes equal to or more than 15, obstruction at initial presentation, and duration of chemotherapy greater than 38 weeks were identified as independent risk factors for decreased five-year disease-free survival after 12 cycles of adjuvant mFOLFOX6. Strategies should be formulated to avoid postponing the schedule of chemotherapy. Modification of adjuvant treatment is warranted in patients with the non-modifiable risk factors.

關鍵字

Colon cancer ； Stage III ； mFOLFOX6 ； Recurrence ； Risk

並列摘要

目的：第三期大腸癌經過手術切除及輔助性化學治療後，仍有部分的病人復發。辨識影響復發的危險因子可能協助病人得到相對應的治療。方法：研究對象為第三期大腸癌的病人，自2006年一月至2015年三月，於臺北榮民總醫院接受大腸腫瘤切除手術及完整輔助性化學治療 （mFOLFOX6）。無病存活率定義為手術日至復發日。我們以Cox proportional hazard model找出可能會影響無病存活率的共變項，並進行多變數分析。結果：合乎研究定義的病人共197位。病人追蹤的時間中位數為6.1年（範圍：0.6～13）。總計56位（28.4%）病人發生復發，17位（8.6%）病人死亡；其中五年內復發之病人共53位（26.9%），死亡之病人共11位（5.6%），五年無病存活率為73.1%，五年整體存活率為94.4%。經多變項Cox model分析後，與術後五年內復發有顯著相關的因子為淋巴結轉移數量大於或等於15個（p = 0.02）、腫瘤合併阻塞（p = 0.03）、接受mFOLFOX6的時間超過38周（p ＜ 0.01）。結論：第三期大腸癌的病人經手術切除及12次輔助性mFOLFOX6後，淋巴結轉移數量大於或等於15個、腫瘤合併阻塞、接受mFOLFOX6的時間超過38周仍為降低五年無病存活率的獨立危險因子。以mFOLFOX6作為輔助性化學治療時，需對會造成延遲每一次化學治療的原因作出相對應的策略。而針對病人合併有無法被人為改變的危險因子，可能須調整輔助性化學治療的方式。

並列關鍵字

大腸癌 ； 第三期 ； 輔助性化學治療 ； 復發 ； 風險

參考文獻

J. M. Jessup, et al. Colon and Rectum. In: M. B. Amin, Eds. AJCC Cancer Staging Manual. 8th. Chicago: Springer, 2017: 251.

R. L. Siegel, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020; 70: 145-164.

N. P. M. Brouwer, et al. An overview of 25 years of incidence, treatment and outcome of colorectal cancer patients. Int J Cancer. 2018; 143: 2758-2766.

I. H. Metwally, et al. Epidemiology and survival of colon cancer among Egyptians: a retrospective study. Journal of Coloproctology. 2018; 38: 24-29.

R. Labianca, et al. Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24 Suppl 6: vi64-72.